FIELD OF THE INVENTION
[0001] The present invention, in some embodiments thereof, relates to the field of urological
medical devices and applications thereof, and more particularly, but not exclusively,
to a urological (prostatic) implant, system, and method for retracting or/and supporting
periurethral tissue enclosing a prostatic urethra along a length of prostate lobes.
BACKGROUND OF THE INVENTION
[0002] Benign prostate hyperplasia (BPH), also known as benign prostatic hypertrophy, is
a urological disease in which the prostate enlarges and constricts the urethra. BPH
affects a majority of the male population over 50 years of age, and is thus of great
medical and commercial importance.
[0003] Surgical treatment of hypertrophy of the prostate has been a routine procedure for
many years. One method of such surgical treatment is open prostatectomy wherein the
gland is totally or partially removed. Another method of surgical treatment is transurethral
resection of the prostate (TURP). Surgical treatment is an invasive procedure that
may be debilitating, painful and traumatic to the patient. Such surgical treatment
may result in various complications including impotence, incontinence, bleeding, infection,
and other undesirable problems.
[0004] Another procedure to treat prostatic hypertrophy is to place a catheter at the external
opening of the urethra and into the obstructed portions of the urethra, allowing urine
to pass from the bladder by way of the catheter lumen. These urinary catheters typically
employ a positioning or retention balloon at the distal tip which inflates at the
bladder neck and prevents the expulsion of the catheter from the body.
[0005] Ablation techniques based on using heat, such as produced by microwave or laser energy,
may be provided in combination with such catheters for treating the enlarged portion
of the prostate. However, such a procedure may result in pain and discomfort to the
patient.
[0006] In spite of extensive teachings and practices in the field of urology, there is an
on-going need for developing and practicing improved and new urological medical devices
and applications thereof, for treating benign prostate hyperplasia (BPH).
SUMMARY OF THE INVENTION
[0007] The present invention, in some embodiments thereof, relates to a urological (prostatic)
implant, system, and method for retracting or/and supporting periurethral tissue enclosing
a prostatic urethra along a length of prostate lobes.
[0008] According to an aspect of some embodiments of the present invention, there is provided
an implant for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, the implant comprising: a distal retractor
incorporating a first and a second craniolateral corners; and a proximal retractor
incorporating a first and a second caudolateral corners; wherein said distal retractor
and proximal retractor are independently actuatable.
[0009] According to some embodiments of the invention, the distal retractor is connected
to, or integrally formed as a single structure with, the proximal retractor, via an
elongated spine member extending along a spinal longitudinal axis or/and a plurality
of elongated edge members.
[0010] According to some embodiments of the invention, the distal retractor or/and the proximal
retractor are in a form of a pair of curved wing-like structures connected to the
spine member via interconnecting members, and symmetrically opposing each other relative
to the spinal longitudinal axis.
[0011] According to some embodiments of the invention, each the interconnecting members
includes at least one elastic portion adjoining the spine member, the elastic portion
being non-stressed when a first of the curved wing-like structures in the pair is
pivotally positioned centrally away from a second of the curved wing-like structures
in the pair about the spinal longitudinal axis, so as to form a predetermined maximal
elongated edge member spanning angle. Optionally, the at least one elastic portion
exhibits an increase in stress when subjected to a moment of force that pivotally
shifts the first curved wing-like structure towards the second curved wing-like structure
about the spinal longitudinal axis.
[0012] According to some embodiments of the invention, the implant further comprises at
least one tissue support member extending between a first elongated edge member and
the spinal longitudinal axis, and at least one other tissue support member extending
between a second elongated edge member and the spinal longitudinal axis, wherein each
tissue support member is sized and configured for supporting a portion of a prostatic
lateral lobe when the spine member engages an anterior interlobar groove that extends
between prostatic lateral lobes in the prostate, and when the first and second elongated
edge members engage corresponding posterolateral interlobar grooves. Optionally, the
spine member has a length being equal to or less than length of the anterior interlobar
groove or/and substantially less than length of each of the first and second elongated
edge members. Optionally, the first elongated edge member is sized for positioning
in a left posterolateral interlobar groove that extends between a left prostatic lateral
lobe and a prostatic medial lobe, and the second elongated edge member is sized for
positioning in a right posterolateral interlobar groove that extends between a right
prostatic lateral lobe and the prostatic medial lobe.
[0013] According to an aspect of some embodiments of the present invention, there is provided
an implant for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, the implant comprising: an elongated spine
member having a spinal longitudinal axis. a first elongated edge member and a second
elongated edge member symmetrically opposing each other relative to the spinal longitudinal
axis, each elongated edge member is interconnected to the spine member via at least
one interconnecting member.
[0014] According to some embodiments of the invention, at least one tissue support member
extending between the first elongated edge member and the spinal longitudinal axis,
and at least one other tissue support member extending between the second elongated
edge member and the spinal longitudinal axis, wherein each tissue support member is
sized and configured for supporting a portion of a prostatic lateral lobe when the
spine member engages an anterior interlobar groove that extends between prostatic
lateral lobes in the prostate, and when the first and second elongated edge members
engage corresponding posterolateral interlobar grooves.
[0015] According to some embodiments of the invention, the spine member has a length being
equal to or less than length of the anterior interlobar groove or/and substantially
less than length of each of the first and second elongated edge members. Optionally,
the first elongated edge member is sized for positioning in a left posterolateral
interlobar groove that extends between a left prostatic lateral lobe and a prostatic
medial lobe, and the second elongated edge member is sized for positioning in a right
posterolateral interlobar groove that extends between a right prostatic lateral lobe
and the prostatic medial lobe.
[0016] According to some embodiments of the invention, each of the interconnecting members
includes at least one elastic portion adjoining the spine member, the elastic portion
being non-stressed when the first and second elongated edge members are pivotally
positioned centrally away from each other about the spinal longitudinal axis, so as
to form a predetermined maximal spanning angle between opposing the interconnecting
members. Optionally, the predetermined maximal spanning angle is within a range of
between about 60° and about 140°. Optionally, the at least one elastic portion exhibits
an increase in stress when subjected to a moment of force that pivotally shifts the
first and second elongated edge members towards each other about the spinal longitudinal
axis. Optionally, the first and second edge members are configured to approach each
other so as to form a spanning angle between opposing the interconnecting members
being equal to or greater than about 60°, when each first and second elongated edge
member or/and each tissue support member exerts a total lateral pressing force upon
a corresponding prostatic lateral lobe, the total lateral pressing force being a range
of between about 100 grams and about 1,000 grams.
[0017] According to some embodiments of the invention, wherein the at least one tissue support
member is configured as a curvilinear portion of the first or/and second elongated
edge member protruding towards the spinal longitudinal axis.
[0018] According to some embodiments of the invention, wherein the at least one tissue support
member is configured as a curvilinear portion of the first or/and second elongated
edge member that protrudes laterally outwardly from an area encompassed by the first
or/and second elongated edge member and the spine member.
[0019] According to some embodiments of the invention, the at least one tissue support member
is configured as a rib or rib-type member extending from one of the interconnecting
members. Optionally, the rib or rib-type member is curved or bent laterally outwardly
from a perimeter of area encompassed by a corresponding the elongated edge member
and the spine member.
[0020] According to some embodiments of the invention, the at least one tissue support member
comprises a tissue contacting surface sized or/and shaped according to dimensions
of the prostatic lateral lobe portion.
[0021] According to some embodiments of the invention, the left and right posterolateral
interlobar grooves, by continuously exerting a radially directed pushing force thereupon,
within a range of between about 100 grams and about 1,000 grams, so as to prevent
or minimize axial or/and rotational movement of the anchored anterior interlobar groove,
and, the left and right posterolateral interlobar grooves.
[0022] According to some embodiments of the invention, the implant is configured to anchor
the anterior interlobar groove, and, the left and right posterolateral interlobar
grooves, by continuously exerting a radially directed pushing force thereupon, so
as to increase distance separating superior portions of the interlobar grooves and
increase distance separating left and right inferior portions of the interlobar grooves,
or/and to maintain a distance of at least 2 mm between the prostatic lateral lobes,
by exerting lateral forces thereupon within a range of between about 100 grams and
about 1,000 grams.
[0023] According to some embodiments of the invention, at least one of the first and second
elongated edge members comprises a cranial-nose portion shaped and configured for
resting against a ledge, imposed by a urinary bladder neck segment adjacent the prostatic
urethra, so as to prevent cranial dislodgement of the implant into urinary bladder,
when the spine member engages an anterior interlobar groove that extends between the
prostatic lateral lobes, and when the first and second elongated edge members engage
corresponding posterolateral interlobar grooves. Optionally, the cranial-nose portion
is "

" shaped.
[0024] According to some embodiments of the invention, at least one of the first and second
elongated edge members comprises a caudal-nose portion shaped and configured for resting
against a narrowing, imposed by external urethral sphincter adjacent to verumontanum
of the prostatic urethra, so as to prevent caudal migration of the implant through
external sphincter and into bulbar urethra, when the spine member engages an anterior
interlobar groove that extends between the prostatic lateral lobes, and when the first
and second elongated edge members engage corresponding posterolateral interlobar grooves.
Optionally, the caudal-nose portion is "L" shaped.
[0025] According to an aspect of some embodiments of the present invention, there is provided
a system for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, the system comprising an implant comprising
a plurality of elongated edge members interconnected in a form of a collapsible-expandable
frame expandable to retract or/and support periurethral tissue by exerting pushing
forces upon interlobar grooves located along the prostatic urethra, wherein a first
one of the elongated edge members includes a first craniolateral corner and a first
caudolateral corner, and a second one of the elongated edge members includes a second
craniolateral corner opposing the first craniolateral corner and a second caudolateral
corner opposing the first caudolateral corner.
[0026] According to some embodiments of the invention, the implant manipulator detachably
connected to the implant first and second elongated edge members, and configured to
manipulate and force the first and second caudolateral corners into close proximity
with each other, configured for progressively or sequentially changing shape or form
of the implant according to different progressive or sequential implant deployment
configurations including at least one of: a fully collapsed delivery configuration,
whereby the first and second craniolateral corners are in close proximity with each
other, and, the first and second caudolateral corners are in close proximity with
each other; a partially collapsed positioning configuration, whereby the first and
second craniolateral corners are distanced apart from each other, and, the first and
second caudolateral corners are in close proximity with each other; and an expanded
deployed configuration, whereby the first and second craniolateral corners are distanced
apart from each other, and, the first and second caudolateral corners are distanced
apart from each other.
[0027] According to some embodiments of the invention, the implant manipulator, when connected
to the implant, is configured for applying thereto at least one of rotational forces,
pulling forces, and pushing forces.
[0028] According to some embodiments of the invention, the implant manipulator comprises
a tubular member and a tether releasably intertwined through both of the implant first
and second caudolateral corners, the implant manipulator is configured for continuously
or/and selectively pulling the implant via an operator using the tether against a
distal end of the tubular member.
[0029] According to some embodiments of the invention, the system further comprises an over
sheath sized for covering a length of a cystoscope having a cystoscope lumen dimensioned
to restrain the implant in the fully collapsed delivery configuration via at least
encircling the implant first and second craniolateral corners.
[0030] According to some embodiments of the invention, the implant manipulator is configured
for facilitating and effecting the progressively or sequentially changing shape or
form of the implant according to the different progressive or sequential implant deployment
configurations. Optionally, the implant manipulator is configured for manipulating
and shifting the implant within the over-sheath between the fully collapsed delivery
configuration and the partially collapsed positioning configuration, by pushing or
pulling the implant relative to the over-sheath lumen until the implant first and
second craniolateral corners are released from the implant manipulator over sheath.
[0031] According to some embodiments of the invention, the implant manipulator is configured
for manipulating and shifting the implant between the partially collapsed delivery
configuration and the expanded deployed configuration by detaching from the implant
after release of the tether from the implant first and second caudolateral corners.
[0032] According to some embodiments of the invention, the partially collapsed positioning
configuration includes the implant having a frustum or cone-like shape whose distal-most
diameter thereof is greater than smallest cross-sectional dimension in a urinary bladder
neck joining the prostatic urethra, and whose proximal-most diameter thereof is smaller
than the smallest cross-sectional dimension in the urinary bladder neck.
[0033] According to some embodiments of the invention, the implant comprises: an elongated
spine member having a spinal longitudinal axis; and a first elongated edge member
and a second elongated edge member symmetrically opposing each other relative to the
spinal longitudinal axis, and interconnected to the spine member via at least one
interconnecting member.
[0034] Optionally, the spine member has a length being equal to or less than length of an
anterior interlobar groove that extends between prostatic lateral lobes, or/and substantially
less than length of each of the first and second elongated edge members. Optionally,
the first elongated edge member is sized for positioning in a left posterolateral
interlobar groove that extends between a left prostatic lateral lobe and a prostatic
medial lobe, and the second elongated edge member is sized for positioning in a right
posterolateral interlobar groove that extends between a right prostatic lateral lobe
and the prostatic medial lobe.
[0035] According to some embodiments of the invention, at least one of the implant first
and second craniolateral corners are shaped and configured for resting against a ledge
imposed by urinary bladder neck so as to prevent cranial dislodgement of the implant
into urinary bladder, when the spine member engages an anterior interlobar groove
that extends between prostatic lateral lobes, and when the first and second elongated
edge members engage corresponding posterolateral interlobar grooves.
[0036] According to some embodiments of the invention, at least one of the implant first
and second caudolateral corners are shaped and configured for resting against a narrowing
imposed by external urethral sphincter adjacent verumontanum of the prostatic urethra,
so as to prevent caudal shift of the implant, when the spine member engages an anterior
interlobar groove that extends between prostatic lateral lobes, and when the first
and second elongated edge members engage corresponding posterolateral interlobar grooves.
Optionally, each of the implant first and second caudolateral corners has a shape
or form of a proximally directed apex, the apex being formed by intersection of converging
curved slopes of respective ones of the implant first and second caudolateral corners.
[0037] According to an aspect of some embodiments of the present invention, there is provided
a method for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, the method comprising providing an implant
along a chosen length of the prostate lobes. Optionally, the method also includes
exerting continuous radially directed pushing forces upon an anterior interlobar groove
between the prostate lobes, and upon at least one of left and right posterolateral
interlobar grooves between the prostate lobes, thereby anchoring the implant in-place.
Optionally, the method also includes exerting lateral pressing forces upon one or
more prostatic lateral lobes, thereby retracting or/and supporting the periurethral
tissue.
[0038] According to an aspect of some embodiments of the present invention, there is provided
a method for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, the method comprising providing an implant
in a fully collapsed delivery configuration, the implant comprises an independently
actuatable distal retractor incorporating first and second craniolateral corners,
and an independently actuatable proximal retractor incorporating first and second
caudolateral corners, wherein the first and second craniolateral corners are in close
proximity to each other, and, the first and second caudolateral corners are in close
proximity to each other.
[0039] Optionally, the method also includes passing the implant in the fully collapsed delivery
configuration, in a cranial direction in a subject's urethra, into the subject's urinary
bladder. Optionally, the method also includes expanding the distal retractor within
inner boundaries of the urinary bladder. Optionally, the method also includes positioning
under vision the implant in the prostatic urethra along the length of the prostate
lobes. Optionally, the method also includes expanding the proximal retractor so as
to effect changing configuration of the implant from the fully collapsed delivery
configuration into an expanded deployed configuration, wherein the first and second
craniolateral corners are distanced apart from each other, and, the first and second
caudolateral corners are distanced apart from each other.
[0040] According to some embodiments of the invention, the providing includes collapsing
the implant from a non-stressed fully opened configuration to the fully collapsed
delivery configuration.
[0041] According to some embodiments of the invention, the collapsing includes at least
one of: urging the first and second caudolateral corners into the close approximation
therebetween, using an implant manipulator, so as to effect the implant into the partially
collapsed positioning configuration; and drawing a compression sleeve over entire
length of the implant, the compression sleeve incorporates a lumen sized for effecting
the implant from the partially collapsed positioning configuration into the fully
collapsed delivery configuration.
[0042] According to some embodiments of the invention, the urging includes pulling a tether,
releasably intertwined through both the first and second caudolateral corners, against
a distal end of a tubular member forming the implant manipulator.
[0043] According to some embodiments of the invention, the passing includes at least one
of: loading the implant manipulator with the implant connected thereto into a lumen
of a urologic cystoscope; and pushing the implant distally through the urethra with
the urologic cystoscope.
[0044] Optionally, the method also includes sleeving an over-sheath over a longitudinal
body of the urologic cystoscope; and extending the over-sheath throughout length of
the urethra with a distal end thereof provided adjacent or inside the urinary bladder.
Optionally, the positioning or the expanding the proximal retractor includes or is
preceded by removing the urologic cystoscope.
[0045] According to some embodiments of the invention, expanding the distal retractor effects
the implant into a partially collapsed positioning configuration, whereby the first
and second craniolateral corners are distanced one with each other, and, the first
and second caudolateral corners are kept in close approximation therebetween.
[0046] Optionally, expanding the distal retractor includes releasing the distal retractor
from a restricting boundary until the distal retractor protrudes in a cranial direction
from a distal end of the over-sheath inner lumen.
[0047] According to some embodiments of the invention, the distal implant comprises an elongated
spine member extending along a spinal longitudinal axis, and a first and a second
elongated edge members connected to the spine member via interconnecting members,
and symmetrically opposing each other relative to the spinal longitudinal axis. Optionally,
the spine member is sized for positioning in an anterior interlobar groove that extends
between lateral prostate lobes in the prostatic urethra. Optionally, the first elongated
edge member is sized for positioning in a left posterolateral interlobar groove that
extends between a left lateral prostate lobe and a middle prostate lobe, and the second
elongated edge member is sized for positioning in a right posterolateral interlobar
groove that extends between a right lateral prostate lobe and a middle prostate lobe.
[0048] According to some embodiments of the invention, positioning includes: rotating the
implant, by applying torque forces, relative to the spinal longitudinal axis so as
to align the spine member with the anterior interlobar groove, or/and to align the
first elongated edge member with the left posterolateral interlobar groove, or/and
to align the second elongated edge member with the right posterolateral interlobar
groove; and visually verifying the alignment using cystoscopy.
[0049] According to some embodiments of the invention, positioning includes pulling the
implant in a caudal direction to a position within the prostatic urethra or/and placing
the first and second craniolateral corners against a narrowing imposed by internal
urethral sphincter adjacent to urine-bladder neck. Optionally, positioning includes
inserting the spine member in the anterior interlobar groove, or/and inserting the
first elongated edge member in the left posterolateral interlobar groove, or/and inserting
the second elongated edge member in the right posterolateral interlobar groove.
[0050] According to some embodiments of the invention, positioning results in the implant,
being in the partially collapsed positioning configuration, expanding a distal region
of the prostatic urethra, using the distal retractor, into a greater lumen size than
an adjacent proximal region of the prosthetic urethra.
[0051] According to some embodiments of the invention, positioning further results in the
distal retractor partially collapsing into conforming with anatomy of the distal region
of the prostatic urethra.
[0052] According to some embodiments of the invention, the implant comprises at least one
tissue support member sized and configured for supporting a portion of a lateral prostatic
lobe following the positioning. Optionally, the method further includes:
leaving the implant to continuously exert radially directed pushing forces upon the
anterior interlobar groove and at least one of the left and right posterolateral interlobar
grooves, so as to prevent or minimize axial or/and rotational movement thereof, or/and
to increase distance separating the superior interlobar grooves and to increase distance
separating the left and right inferior-lateral interlobar grooves.
[0053] According to some embodiments of the invention, leaving the implant includes exerting
lateral pressing forces upon each lateral prostate lobe, thereby retracting or/and
supporting the periurethral tissue.
[0054] Optionally, the method comprises repeating at least one of expanding the distal retractor,
positioning and expanding the proximal retractor until reaching a chosen result. Optionally,
repeating includes: re-collapsing the implant back into the fully collapsed delivery
configuration; and passing the implant back into a urinary bladder.
[0055] According to some embodiments of the invention, the chosen result is verified under
vision. Optionally, the chosen result includes anchoring different portions of the
implant in at least two of anterior interlobar groove, left posterolateral interlobar
groove, and right posterolateral interlobar groove of the prostatic urethra within
the boundaries of the prostate lobes. Optionally, the chosen result includes lifting
both lateral prostate lobes so as to enlarge minimal lumen size of the prostatic urethra
to at least 1 mm along a continuous length thereof.
[0056] According to some embodiments of the invention, lifting includes shifting each the
lateral prostate lobe, pivotally, relatively to the anterior interlobar groove.
[0057] All technical or/and scientific words, terms, or/and phrases, used herein have the
same or similar meaning as commonly understood by one of ordinary skill in the art
to which the invention pertains,
unless otherwise specifically defined or stated herein. Methods, materials, and examples described herein are illustrative only and are not
intended to be necessarily limiting. Although methods or/and materials equivalent
or similar to those described herein can be used in practicing or/and testing embodiments
of the invention, exemplary methods or/and materials are described below. In case
of conflict, the patent specification, including definitions, will control.
[0058] Implementation of some embodiments of the invention can involve performing or completing
selected tasks manually, automatically, or a combination thereof. Moreover, according
to actual instrumentation and equipment of some embodiments of the invention, several
selected tasks could be implemented by hardware, by software, by firmware, or a combination
thereof, using a computerized operating system.
[0059] The invention can also be understood with reference to the following numbered clauses:
- 1. An implant for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, the implant comprising:
a distal retractor incorporating a first and a second craniolateral corners; and
a proximal retractor incorporating a first and a second caudolateral corners;
wherein said distal retractor and proximal retractor are independently actuatable.
- 2. The implant of clause 1, wherein said distal retractor is connected to, or integrally
formed as a single structure with, said proximal retractor, via an elongated spine
member extending along a spinal longitudinal axis or/and a plurality of elongated
edge members.
- 3. The implant of clause 2, wherein said distal retractor or/and said proximal retractor
are in a form of a pair of curved wing-like structures connected to said spine member
via interconnecting members, and symmetrically opposing each other relative to said
spinal longitudinal axis.
- 4. The implant of clause 3, wherein each said interconnecting members includes at
least one elastic portion adjoining said spine member, said elastic portion being
non-stressed when a first of said curved wing-like structures in said pair is pivotally
positioned centrally away from a second of said curved wing-like structures in said
pair about said spinal longitudinal axis, so as to form a predetermined maximal elongated
edge member spanning angle.
- 5. The implant of clause 4, wherein said at least one elastic portion exhibits an
increase in stress when subjected to a moment of force that pivotally shifts said
first curved wing-like structure towards said second curved wing-like structure about
said spinal longitudinal axis.
- 6. The implant of clause 2, further comprising at least one tissue support member
extending between a first elongated edge member and said spinal longitudinal axis,
and at least one other tissue support member extending between a second elongated
edge member and said spinal longitudinal axis, wherein each said tissue support member
is sized and configured for supporting a portion of a prostatic lateral lobe when
said spine member engages an anterior interlobar groove that extends between prostatic
lateral lobes in the prostate, and when said first and second elongated edge members
engage corresponding posterolateral interlobar grooves.
- 7. The implant of clause 6, wherein said spine member has a length being equal to
or less than length of said anterior interlobar groove or/and substantially less than
length of each of said first and second elongated edge members.
- 8. The implant of clause 7, wherein said first elongated edge member is sized for
positioning in a left posterolateral interlobar groove that extends between a left
prostatic lateral lobe and a prostatic medial lobe, and said second elongated edge
member is sized for positioning in a right posterolateral interlobar groove that extends
between a right prostatic lateral lobe and said prostatic medial lobe.
- 9. An implant for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length prostate lobes, the implant comprising:
an elongated spine member having a spinal longitudinal axis;
a first elongated edge member and a second elongated edge member symmetrically opposing
each other relative to said spinal longitudinal axis, each said elongated edge member
is interconnected to said spine member via at least one interconnecting member; and
at least one tissue support member extending between said first elongated edge member
and said spinal longitudinal axis, and at least one other tissue support member extending
between said second elongated edge member and said spinal longitudinal axis, wherein
each sad tissue support member is sized and configured for supporting a portion of
a prostatic lateral lobe when said spine member engages an anterior interlobar groove
that extends between prostatic lateral lobes in the prostate, and when said first
and second elongated edge members engage corresponding posterolateral interlobar grooves.
- 10. The implant of clause 9, wherein said spine member has a length being equal to
or less than length of said anterior interlobar groove or/and substantially less than
length of each of said first and second elongated edge members.
- 11. The implant of clause 10, wherein said first elongated edge member is sized for
positioning in a left posterolateral interlobar groove that extends between a left
prostatic lateral lobe and a prostatic medial lobe, and said second elongated edge
member is sized for positioning in a right posterolateral interlobar groove that extends
between a right prostatic lateral lobe and said prostatic medial lobe.
- 12. The implant of clause 9, wherein each of said interconnecting members includes
at least one elastic portion adjoining said spine member, said elastic portion being
non-stressed when said first and second elongated edge members are pivotally positioned
centrally away from each other about said spinal longitudinal axis, so as to form
a predetermined maximal spanning angle between opposing said interconnecting members.
- 13. The implant of clause 12, wherein said predetermined maximal spanning angle is
within a range of between about 60° and about 140°.
- 14. The implant of clause 12, wherein said at least one elastic portion exhibits an
increase in stress when subjected to a moment of force that pivotally shifts said
first and second elongated edge members towards each other about said spinal longitudinal
axis.
- 15. The implant of clause 12, wherein said first and second edge members are configured
to approach each other so as to form a spanning angle between opposing said interconnecting
members being equal to or greater than about 60°, when each said first and second
elongated edge member or/and each said tissue support member exerts a total lateral
pressing force upon a corresponding said prostatic lateral lobe, said total lateral
pressing force being a range of between about 100 grams and about 1,000 grams.
- 16. The implant of clause 9, wherein said at least one tissue support member is configured
as a curvilinear portion of said first or/and second elongated edge member protruding
towards said spinal longitudinal axis.
- 17. The implant of clause 9, wherein said at least one tissue support member is configured
as a curvilinear portion of said first or/and second elongated edge member that protrudes
laterally outwardly from an area encompassed by said first or/and second elongated
edge member and said spine member.
- 18. The implant of clause 9, wherein said at least one tissue support member is configured
as a rib or rib-type member extending from one of said interconnecting members.
- 19. The implant of clause 18 , wherein said rib or rib-type member is curved or bent
laterally outwardly from a perimeter of area encompassed by a corresponding said elongated
edge member and said spine member.
- 20. The implant of clause 9, wherein said at least one tissue support member comprises
a tissue contacting surface sized or/and shaped according to dimensions of said prostatic
lateral lobe portion.
- 21. The implant of clause 11, configured to anchor said anterior interlobar grooves,
and, said left and right posterolateral interlobar grooves, by continuously exerting
a radially directed pushing force thereupon, within a range of between about 100 grams
and about 1,000 grams, so as to prevent or minimize axial or/and rotational movement
of said anchored anterior interlobar groove, and, said left and right posterolateral
interlobar grooves.
- 22. The implant of clause 11, configured to anchor said anterior interlobar groove,
and, said left and right posterolateral interlobar grooves, by continuously extering
a radially directed pushing force thereupon, so as to increase distance separating
superior portions of said interlobar grooves and increase distance separating left
and right inferior portions of said interlobar grooves, or/and to maintain a distance
of at least 2 mm between said prostatic lateral lobes, by exerting lateral forces
thereupon within a range of between about 100 grams and about 1,000 grams.
- 23. The implant of clause 9, wherein at least one of said first and second elongated
edge members comprises a cranial-nose portion shaped and configured for resting against
a ledge, imposed by a urinary bladder neck segment adjacent to prostatic urethra,
so as to prevent cranial dislodgement of the implant into urinary bladder, when said
spine member engages an anterior interlobar groove that extends between said prostatic
lateral lobes, and when said first and second elongated edge membes engage corresponding
posterolateral interlobar grooves.
- 24. The implant of clause 23, wherein said cranial-nose portion is "L" shaped.
- 25. The implant of clause 9, wherein at least one of said first and second elongated
edge members comprises a caudal-nose portion shaped and configured for resting against
a narrowing, imposed by external urethral sphincter adjacent to verumontanum of the
prostatic urethra, so as to prevent caudal migration of the implant through external
sphincter and into bulbar urethra, when said spine member engages an anterior interlobar
groove that extends between said prostatic lateral lobes, and when said first and
second elongated edge members engage corresponding posterolateral interlobar grooves.
- 26. The implant of clause 25, wherein said caudal-nose portion is "L" shaped.
- 27. A system for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, the system comprising:
an implant comprising a plurality of elongated edge members interconnected in a form
of a collapsible-expandable frame expandable to retract or/and support periurethral
tissue by exerting pushing forces upon interlobar grooves locate along the prostatic
urethra, wherein a first one of said elongated edge members includes a first craniolateral
corner and a first caudolateral corner, and a second one of said elongated edge members
includes a second craniolateral corner opposing said first craniolateral corner and
a second caudolateral corner opposing said first caudolateral corner; and
an implant manipulator detachably connected to said implant first and second elongated
edge members, and configured to manipulate and force said first and second caudolateral
corers into close proximity with each other.
- 28. The system of clause 27, wherein said implant manipulator is configured for progressively
or sequentially changing shape or form of said implant according to different progressive
or sequential implant deployment configurations including at least one of:
a fully collapsed delivery configuration, whereby said first and second craniolateral
corners are in close proximity with each other, and, said first and second caudolateral
corners are in close proximity with each other;
a partially collapsed positioning configuration, whereby said first and second craniolateral
corners are distanced apart from each other, and, said first and second caudolateral
corners are in close proximity with each other; and
an expanded deployed configuration, whereby said first and second craniolateral corners
are distanced apart from each other, and, said first and second caudolateral corners
are distanced apart from each other.
- 29. The system of clause 27, wherein said implant manipulator, when connected to said
implant, is configured for applying thereto at least one of rotational forces, pulling
forces, and pushing forces.
- 30. The system of clause 27, wherein said implant manipulator comprises a tubular
member and a tether releasably intertwined through both of said implant first and
second caudolateral corners, said implant manipulator is configured for continuously
or/and selectively pulling said implant via an operator using said tether against
a distal end of said tubular member.
- 31. The system of clause 28, further comprising an over sheath sized for covering
a length of a cystoscope having a cystoscope lumen dimensioned to restrain said implant
in said fully collapsed delivery configuration via at least encircling said implant
first and second craniolateral corners.
- 32. The system of clause 28, wherein said implant manipulator is configured for facilitating
and effecting said progressively or sequentially changing shape or form of said implant
according to said different progressive or sequential implant deployment configurations.
- 33. The system of clause 31, wherein said implant manipulator is configured for manipulating
and shifting said implant within said over-sheath between said fully collapsed delivery
configuration and said partially collapsed positioning configuration, by pushing or
pulling said implant relative to said over-sheath lumen until said implant first and
second craniolateral corners are released from said implant manipulator over sheath.
- 34. The system of clause 28, wherein said implant manipulator is configured manipulating
and shifting said implant between said partially collapsed delivery configuration
and said expanded deployed configuration by detaching from said implant after release
of said tether from said implant first and second caudolateral corners.
- 35. The system of clause 28, wherein said partially collapsed positioning configuration
includes said implant having a frustum or cone-like shape whose distal-most diameter
thereof is greater than smallest cross-sectional dimension in a urinary bladder neck
joining the prostatic urethra, and whose proximal-most diameter thereof is smaller
than said smaller cross-sectional dimension in said urinary bladder neck.
- 36. The system of clause 27, wherein said implant comprises:
an elongated spine member having a spinal longitudinal axis; and
a first elongated edge member and a second elongated edge member symmetrically opposing
each other relative to said spinal longitudinal axis, and interconnected to said spin
member via at least one interconnecting member.
- 37. The system of clause 36, wherein said spine member has a length being equal to
or less than length of an anterior interlobal groove that extends between prostatic
lateral lobes, or/and substantially less than length of each of said first and second
elongated edge members.
- 38. The system of clause 37, wherein said first elongated edge member is sized for
positioning in a lest posterolateral interlobal groove that extends between a left
prostatic lateral lobe and a prostatic medial lobe, and said second elongated edge
member is sized for positioning in a right posterolateral interlobar groove that extends
between a right prostatic lateral lobe and said prostatic medial lobe.
- 39. The system of clause 27, wherein at least one of said implant first and second
craniolateral corners are shaped and configured for resting against a ledge imposed
by urinary bladder neck so as to prevent cranial dislodgement of said implant into
urinary bladder, when said spine member engages an anterior interlobal groove that
extends between prostatic lateral lobes, and when said first and second elongated
edge members engage corresponding posterolateral interlobar grooves.
- 40. The system of clause 27, wherein at least one of said implant first and second
caudolateral corners are shaped and configured for resting against a narrowing imposed
by external urethral sphincter adjacent verumontanum of the prostatic urethra, so
as to prevent caudal shift of said implant, when said spine member engage an anterior
interlobar groove that extends between prostatic lateral lobes, and when said first
and second elongated edge members engage corresponding posterolateral interlobar grooves.
- 41. The system of clause 40, wherein said each of said implant first and second caudolateral
corners has a shape or form of a proximally directed apex, said apex being formed
by intersection of converging curved slopes of respective ones of said implant first
and second caudolatral corners.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0060] Some embodiments of the present invention are herein described, by way of example
only, with reference to the accompanying drawings. With specific reference now to
the drawings in detail, it is stressed that the particulars shown are by way of example
and for purposes of illustrative description of some embodiments of the present invention.
In this regard, the description taken together with the accompanying drawings make
apparent to those skille4d in the art how some embodiments of the present invention
may be practiced.
[0061] In the drawings:
FIG. 1A schematically illustrates a cross sectional side view of a typical human anatomical
region encompassing the lower part of the bladder, the prostate, and the prostatic
urethra, absent of benign prostate hyperplasia (BPH);
FIG. 1B schematically illustrates a cross sectional top view of a portion of the anatomical
region shown in FIG. 1A (dashed line double arrow 1B---1B therein), highlighting exemplary
relative positions, configurations, and sizes of a prostatic urethra in a normal open
condition and selected prostatic lobes [dashed line circles];
FIG. 1C schematically illustrates a cross sectional top view of the same portion of
the anatomical region shown in FIG. 1A, exhibiting benign prostate hyperplasia (BPH),
highlighting exemplary relative positions, configurations, and sizes of the prostatic
urethra in an abnormal compressed condition and selected prostatic lobes [dashed line
circles];
FIG. 2A schematically illustrates a side view of an exemplary embodiment of an implant
for retracting or/and supporting periurethral tissue enclosing a prostatic urethra
along a length of prostate lobes, highlighting some prostatic implant components,
in accordance with some embodiments of the invention;
FIG. 2B schematically illustrates the exemplary implant shown in FIG. 2A, highlighting
the implant distal retractor exhibiting a non-stressed configuration, and the implant
proximal retractor exhibiting a stressed configuration, in accordance with some embodiments
of the invention;
FIG. 2C schematically illustrates the exemplary implant shown in FIG. 2A, highlighting
the implant distal and proximal retractors exhibiting a non-stressed configuration,
in accordance with some embodiments of the invention;
FIG. 2D schematically illustrates a front view of the prostatic implant shown in FIG.
2A exhibiting a stressed configuration, in accordance with some embodiments of the
invention;
FIG. 2E schematically illustrates a front view of the prostatic implant shown in FIG.
2C exhibiting a non-stressed configuration, in accordance with some embodiments of
the invention;
FIG. 3A schematically illustrates the exemplary embodiment of the stressed prostatic
implant shown in FIG. 2D immediately following insertion thereof into the (BPH exhibiting)
anatomical region portion shown in FIG. 1C, highlighting exemplary (insertion stage)
positioning and configuration of the stressed prostatic implant relative to the (compressed)
prostatic urethra and prostatic lobes [dashed line circles];
FIG. 3B schematically illustrates the exemplary prostatic implant shown in FIG. 3A
following release thereof inside the (BPH exhibiting) anatomical region portion shown
in FIG. 1C, highlighting exemplary (release stage) positioning and configuration of
the non-stressed prostatic implant relative to the (compressed) prostatic urethra
and prostatic lobes [dashed line circles];
FIG. 4A - 4C schematically illustrate perspective, front, and top views, respectively,
of another exemplary embodiment of an implant for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes, highlighting
some prostatic implant components, in accordance with some embodiments of the invention;
FIG. 5 schematically illustrates the exemplary prostatic implant shown in FIG. 4C,
highlighting inclusion therein of a plurality of exemplary tissue support members,
each configured as a rib or rib-type member, in accordance with some embodiments of
the invention;
FIG. 6 schematically illustrates the exemplary prostatic implant shown in FIG. 4C,
highlighting inclusion therein of a pair of exemplary tissue support members with
each member including a tissue contacting surface, in accordance with some embodiments
of the invention;
FIG. 7A schematically illustrates an exemplary embodiment of a system for retracting
or/and supporting periurethral tissue enclosing a prostatic urethra along a length
of prostate lobes, highlighting some system components, wherein an exemplary prostatic
implant (such as that shown in FIGs. 4A and 4C), in a stressed configuration and operatively
connected to an exemplary cystoscope, is entirely held within an exemplary compression
sleeve by an implant manipulator, in accordance with some embodiments of the invention;
FIGs. 7B - 7C schematically illustrate exemplary embodiments of the system shown in
FIG. 7A, highlighting progressive (sequential) stages of operation thereof, wherein
the exemplary prostatic implant is deployed via progressively (sequentially) being
pushed out of the compression sleeve by the implant manipulator, in accordance with
some embodiments of the invention;
FIG. 7D schematically illustrates the exemplary prostatic implant shown in FIGs. 7A
- 7C, following deployment by the system, in a 'stand-alone' non-stressed expanded
configuration after exiting the compression sleeve and detachment from the implant
manipulator, in accordance with some embodiments of the invention; and
FIGs. 8A - 8N schematically illustrate components and operation of an exemplary system
(such as prostatic implant system 400 shown in FIGs. 7A - 7C), including various stages
of delivering and deploying an exemplary prostatic implant (such as prostatic implant
300 shown in FIGs. 4A, 4C, and 7D), for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes, in accordance
with some embodiments of the invention.
DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION
[0062] The present invention, in some embodiments thereof, relates to the field of urological
medical devices and applications thereof, and more particularly, but not exclusively,
to a urological (prostatic) implant, system, and method for retracting or/and supporting
periurethral tissue enclosing a prostatic urethra along a length of prostate lobes.
[0063] As briefly explained hereinabove in the Background section, benign prostate hyperplasia
(hypertrophy) (BPH) is commonly treated by surgical techniques, catheter based techniques,
or/and ablation techniques, among other known techniques. Treating subjects having
BPH by such techniques may involve, or cause, any number of various complications
and problems. Such complications and problems may be directly associated with performing
a given BPH treatment technique itself, for example, as directly relating to equipment
(medical devices) or/and procedures (methods) used in a surgical technique, a catheter
based technique, or an ablation technique. Alternatively, or additionally, situations
may arise where such complications and problems are not be directly associated with
performing a given BPH treatment technique itself, however, they may be an indirect
result or unintended consequence (e.g., side effect) during or/and after performing
a given BPH treatment technique.
[0064] Some embodiments of the presently disclosed invention are suitable for treating subjects
having conditions of benign prostate hyperplasia (hypertrophy) (BPH), where such treatment
is expected to be absent of various possible complications and problems of, or associated
with, known BPH treatment techniques. Accordingly, implementation and practice of
some embodiments of the present invention may provide at least some solutions to at
least some problems associated with known teachings in the field of urological medical
devices and applications thereof that are currently used for treating subjects having
BPH.
[0065] For purposes of better understanding embodiments of the present invention, in the
following illustrative description thereof, reference is made to the figures. Throughout
the following description and accompanying drawings, same reference notation and terminology
(i.e., numbers, letters, symbols, terms, and phrases) are consistently used and refer
to same components, elements, or features. It is to be understood that the invention
is not necessarily limited in its application to particular details of construction
or/and arrangement of device, apparatus, or/and system components, or to any particular
sequential ordering of method steps or procedures, set forth in the following illustrative
description. The invention is capable of other embodiments or of being practiced or
carried out in various ways.
[0066] Referring now to the drawings, FIG. 1A schematically illustrates a cross sectional
side view of a typical human anatomical region 100 encompassing the lower part of
the urinary bladder 102, the prostate 104, and the prostatic urethra 106, where the
anatomical region is absent of benign prostate hyperplasia (BPH). The prostatic urethra
106 is surrounded by and extends through the prostate 104 towards the bladder neck
108 of the urinary bladder 102.
[0067] In the context of schematically illustrating and visualizing benign prostate hyperplasia
(BPH), of particular interest are characteristics and parameters of, or relating to,
position, configuration, and size (diameter) of the prostatic urethra 106 relative
to those of the various prostatic lobes of the prostate 104 surrounding the prostatic
urethra 106. FIG. 1B schematically illustrates a cross sectional top view of a portion
110 of the anatomical region 100 shown in FIG. 1A (indicated by the dashed line double
arrow 1B---1B therein), highlighting exemplary relative positions, configurations,
and sizes of a prostatic urethra 106 in a normal open condition and selected prostatic
lobes [dashed line circles], namely, left and right prostatic lateral lobes 114a and
114b, respectively, and prostatic medial lobe 116, during 'normal' conditions absent
of BPH.
[0068] FIG. 1C schematically illustrates a cross sectional top view of the same portion
110 of the anatomical region 100 shown in FIG. 1A, exhibiting benign prostate hyperplasia
(BPH), highlighting exemplary relative positions, configurations, and sizes of the
prostatic urethra 112 in an abnormal compressed condition and selected prostatic lobes
[dashed line circles], namely, left and right prostatic lateral lobes 114a and 114b,
respectively, and prostatic medial lobe 116, during 'abnormal' conditions due to BPH.
For additional illustrative purposes, FIG. 1C also shows the anterior interlobar groove
118, and, the left and right posterolateral interlobar grooves 120a and 120b, respectively,
so formed as a result of 'abnormal' enlargement of prostatic lobes 114a, 114b, and
116, along with 'abnormal' compression of prostatic urethra 106.
[0069] In the context of the relevant medical fields relating to, and associated with, the
present invention, for the purpose of further enhancing understanding of the illustrative
description of the numerous exemplary embodiments of the invention, herein following
are meanings of structural and anatomical reference directions used in the hereinbelow
illustrative description. The following meanings are presented in a non-limiting manner,
whereby, other similar meanings may also be applicable to exemplary embodiments of
the herein disclosed invention.
[0070] The term 'distal' (direction), as used herein, refers to the direction away from
a medical practitioner performing a method or using a device, and closer to a subject's
body or towards the midline of the subject's body. The term 'proximal' (direction),
as used herein, refers to the direction towards the medical practitioner performing
a method or using a device, and farther from a subject's body or away from the midline
of the subject's body.
[0071] The term 'cranial' (direction), as used herein, refers to the direction generally
towards a subject's head or brain, or, for example, in a direction towards a urinary
bladder and away from a prostate of same subject. The term 'caudal' (direction), as
used herein, refers to the direction opposite that of a subject's head or brain, or/and
situated in or directed toward the part of the subject's body from which the tail
arises.
[0072] The term 'anterior' (direction), as used herein, refers to the direction towards
the front plane of a subject's body. The term posterior' (direction), as used herein,
refers to the direction towards the rear plane of a subject's body.
[0073] The term 'lateral' (direction), as used herein, refers to the direction away from
the median and sagittal plane of a subject's body. The term 'medial' (direction),
as used herein, refers to the direction towards the median and sagittal plane of a
subject's body.
[0074] An aspect of some embodiments of the present invention is an implant (herein, also
referred to as a prostatic implant) for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes. FIG. 2A schematically
illustrates a side view of an exemplary embodiment of an implant (indicated as, and
referred to by, reference number 200) for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes, highlighting
some prostatic implant components. Exemplary prostatic implant 200, in a non-limiting
manner, includes: a distal retractor 202 incorporating a first craniolateral corner
204a and a second craniolateral corner 204b, and a proximal retractor 206 incorporating
a first caudolateral corner 208a and a second caudolateral corner 208b.
[0075] In exemplary embodiments, the prostatic implant 200 additionally includes an elongated
spine member 210. In such exemplary embodiments, the distal retractor 202 is connected
to, or integrally formed as a single structure with, the proximal retractor 206, via
the elongated spine member 210 extending along a spinal longitudinal axis 212 or/and
a plurality of elongated edge members 214 and 216.
[0076] In exemplary embodiments, the distal retractor 202 and the proximal retractor 206
are independently actuatable. Specifically, actuation (i.e., movement or/and change
in configuration, shape or form, or/and position) of the distal retractor 202 is independent
of actuation (movement or/and change in configuration, shape or form, or/and position)
of the proximal retractor 206, and vice versa. Such independent actuation of the distal
retractor 202 and the proximal retractor 206 is exemplified in FIGs. 2B and 2C. FIG.
2B schematically illustrates the exemplary prostatic implant 200 shown in FIG. 2A,
highlighting the implant distal retractor 202 exhibiting a non-stressed configuration,
and the implant proximal retractor 206 exhibiting a stressed configuration. FIG. 2C
schematically illustrates the exemplary prostatic implant 200, highlighting both the
implant distal retractor 202 and the proximal retractor 206 exhibiting a non-stressed
configuration.
[0077] Accordingly, exemplary prostatic implant 200 is capable of undergoing a structural
change in a manner whereby, for example, the distal retractor 202 is not actuated
and remains in a non-stressed configuration (as shown in both FIGs. 2B and 2C), whereas
the proximal retractor 206 is actuated and changes or shifts from a stressed configuration
(FIG. 2B) to a non-stressed configuration (FIG. 2C). Such actuation, in the form of
configurational change or shift, of the proximal retractor 206 is independent of non-actuation
of the distal retractor 202.
[0078] An additional example showing preceding illustratively described structural change
of the exemplary prostatic implant 200 is provided in FIGs. 2D - 2E. FIG. 2D schematically
illustrates a front view of the prostatic implant 200 shown in FIG. 2A exhibiting
a stressed configuration, while FIG. 2E schematically illustrates a front view of
the prostatic implant 200 shown in FIG. 2C exhibiting a non-stressed configuration.
Such structural change of the exemplary prostatic implant 200 (in changing from a
stressed configuration of FIG. 2D to a non-stressed configuration of FIG. 2E) is accompanied
by radially directed forces outwardly originating from the distal and proximal retractors
202 and 206, respectively, in a manner such that the prostatic implant 200 laterally
expands and changes from a stressed configuration (FIG. 2D) to a non-stressed configuration
(FIG. 2E).
[0079] Exemplary implementation and use of a prostatic implant, for example, prostatic implant
200, for retracting or/and supporting periurethral tissue enclosing a prostatic urethra
along a length of prostate lobes, according to some embodiments of the invention,
are illustratively described with reference to FIGs. 3A and 3B.
[0080] FIG. 3A schematically illustrates the exemplary embodiment of the stressed prostatic
implant 200 shown in FIG. 2D immediately following insertion thereof into the (BPH
exhibiting) anatomical region portion 110 shown in FIG. 1C. FIG. 3A highlights exemplary
(insertion stage) positioning and configuration of the stressed prostatic implant
200 relative to the compressed prostatic urethra 106 and the prostatic lobes (left
and right prostatic lateral lobes 114a and 114b, respectively, and prostatic medial
lobe 116).
[0081] FIG. 3B schematically illustrates the exemplary prostatic implant 200 shown in FIG.
3A following release thereof inside the (BPH exhibiting) anatomical region portion
110. FIG. 3B highlights exemplary (release stage) positioning and configuration of
the prostatic implant 200 now being 'less-stressed' (e.g., by undergoing elastic deformation
under smaller external stresses, resulting in less strain thereof) relative to the
compressed prostatic urethra 106 and the prostatic lobes. Structural change of the
prostatic implant 200 (in changing from a stressed configuration of FIG. 3A to a non-stressed
configuration of FIG. 3B) is accompanied by radially directed forces FR outwardly
originating from the distal and proximal retractors 202 and 206, respectively, in
a manner such that the prostatic implant 200 laterally expands and changes from a
stressed configuration (FIG. 3A) to a partially- or less-stressed configuration (FIG.
3B). This, at least, effects anchoring of implant 200 within the particular anatomy
of the BPH prostatic urethra, which prevents dislodgement or migration thereof in
cranial or caudal directions, as well as rotational movement. Moreover, such structural
change of the prostatic implant 200, via the radially directed forces FR outwardly
originating from the distal and proximal retractors 202 and 206, respectively, translates
into laterally directed pushing or pressure forces FL exerted by the distal and proximal
retractors 202 and 206, respectively, upon those potions of the prostatic lobes (left
and right prostatic lateral lobes 114a and 114b, respectively, and prostatic medial
lobe 116) in contact with the prostatic implant 200, in general, and in contact with
the distal and proximal retractors 202 and 206, respectively, in particular.
[0082] Additional exemplary and optional technical features, characteristics, and properties
of an implant, for example, prostatic implant 200, for retracting or/and supporting
periurethral tissue enclosing a prostatic urethra along a length of prostate lobes,
according to some embodiments of the invention, are illustratively described as follows.
[0083] In exemplary embodiments, the distal retractor 202 or/and the proximal retractor
206 are in a form of a pair of first and second curved wing-like structures connected
to spine member 210 via interconnecting members 217, and symmetrically opposing each
other relative to the spinal longitudinal axis 212. In exemplary embodiments, each
interconnecting member includes at least one elastic portion, for example, elastic
portion 218, adjoining the spine member 210, such that the elastic portion is non-stressed
when the first curved wing-like structure in the pair is pivotally positioned centrally
away from the second curved wing-like structure in the pair about the spinal longitudinal
axis 212, so as to form a predetermined maximal elongated edge member spanning angle.
In exemplary embodiments, each elastic portion adjoining the spine member 210 exhibits
an increase in stress (e.g., bending or/and compression) when subjected to a moment
of force that pivotally shifts the first curved wing-like structure towards the second
curved wing-like structure about the spinal longitudinal axis 212.
[0084] In exemplary embodiments, the prostatic implant 200 additionally includes at least
one tissue support member extending between a first elongated edge member, for example,
first elongated edge member 214, and the spinal longitudinal axis 212, and at least
one other tissue support member extending between a second elongated edge member,
for example, second elongated edge member 216, and the spinal longitudinal axis 212.
In exemplary embodiments, each tissue support member is sized and configured for supporting
a portion of a prostatic lateral lobe, for example, left prostatic lateral lobe 114a
or right prostatic lateral lobe 114b, when the spine member 210 engages an anterior
interlobar groove, for example, anterior interlobar groove 118, that extends between
left and right prostatic lateral lobes 114a and 114b, respectively, and when the first
and second elongated edge members 214 and 216, respectively, engage corresponding
posterolateral interlobar grooves, for example, left and right posterolateral interlobar
grooves 120a and 120b, respectively.
[0085] In exemplary embodiments, the spine member 210 has a length being equal to or less
than length of the anterior interlobar groove 118 or/and substantially less than the
length of each of the first and second elongated edge members 214 and 216, respectively.
In exemplary embodiments, the first elongated edge member 214 is sized for positioning
in the left posterolateral interlobar groove 120a that extends between the left prostatic
lateral lobe 114a and the prostatic medial lobe 116, and the second elongated edge
member 216 is sized for positioning in the right posterolateral interlobar groove
120b that extends between the right prostatic lateral lobe 114b and the prostatic
medial lobe 116.
[0086] FIGs. 4A - 4C schematically illustrate a perspective view, a frontal view, and a
top view, respectively, of another exemplary embodiment of an implant (indicated as,
and referred to by, reference number 300) for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes, highlighting
some prostatic implant components. According to such an exemplary embodiment, exemplary
prostatic implant 300, in a non-limiting manner, includes: a distal retractor 302
incorporating a first craniolateral corner 304a and a second craniolateral corner
304b, and a proximal retractor 306 incorporating a first caudolateral corner 308a
and a second caudolateral corner 308b.
[0087] In exemplary embodiments, the prostatic implant 300 additionally includes an elongated
spine member 310. In such exemplary embodiments, the distal retractor 302 is connected
to, or integrally formed as a single structure with, the proximal retractor 306, via
the elongated spine member 310 extending along a spinal longitudinal axis 312 or/and
a plurality of elongated edge members, for example, first and second elongated edge
members, 314 and 316, respectively.
[0088] In exemplary embodiments, the distal retractor 302 and the proximal retractor 306
are independently actuatable. Specifically, actuation (i.e., movement or/and change
in configuration, shape or form, or/and position) of the distal retractor 302 is at
least partly, or entirely, independent of actuation (movement or/and change in configuration,
shape or form, or/and position) of the proximal retractor 306, and vice versa. In
exemplary embodiments, such actuation may be in the form of an 'indirect' actuation,
for example, by indirectly actuating the distal retractor 302 or/and the proximal
retractor 306 using external means. In such exemplary embodiments, the indirect external
means may include or involve using an implant delivery system, for example, in a form
of an operative combination of an implant manipulator and a compression sleeve, for
example, implant manipulator 410 and compression sleeve 404 illustratively described
hereinbelow and shown in FIGs. 7A - 7C, and 8A - 8L, in the context of an exemplary
embodiment of a prostatic implant system).
[0089] Independent actuation of the distal retractor 302 and the proximal retractor 306
of prostatic implant 300 is analogous to that exemplified for the distal retractor
202 and the proximal retractor 206 of prostatic implant 200 shown in FIGs. 2B and
2C. Thus, similar to that shown in FIG. 2B, for the exemplary prostatic implant 300
shown in FIGs. 4A - 4C, the implant distal retractor 302 may exhibit a non-stressed
configuration, while the implant proximal retractor 306 may exhibit a stressed configuration.
Additionally, similar to that shown in FIG. 2C, for the exemplary prostatic implant
300, both the implant distal retractor 302 and the proximal retractor 306 may exhibit
a non-stressed configuration.
[0090] Accordingly, exemplary prostatic implant 300 is capable of undergoing a structural
change in a manner whereby, for example, the distal retractor 302 is not actuated
and remains in a non-stressed configuration (analogous to that shown in both FIGs.
2B and 2C), whereas the proximal retractor 306 is actuated and changes or shifts from
a stressed configuration (analogous to that shown in FIG. 2B) to a non-stressed configuration
(analogous to that shown in FIG. 2C). Such actuation, in the form of configurational
change or shift, of the proximal retractor 306 is independent of non-actuation of
the distal retractor 302.
[0091] Preceding illustratively described structural change of the exemplary prostatic implant
300 shown in FIGs. 4A - 4C is analogous to that illustratively described hereinabove
regarding structural change of the exemplary prostatic implant 200 as shown in FIGs.
2D - 2E. Accordingly, such structural change of the exemplary prostatic implant 300
in changing from a stressed (e.g., compressed) configuration (analogous to that shown
in FIG. 2D) to a non-stressed (e.g., non-compressed) configuration (analogous to that
shown in FIG. 2E), is accompanied by radially directed forces outwardly originating
from the distal and proximal retractors 302 and 306, respectively, in a manner such
that the prostatic implant 300 laterally expands and changes from a stressed configuration
to a non-stressed configuration.
[0092] Exemplary implementation and use of the prostatic implant 300, for retracting or/and
supporting periurethral tissue enclosing a prostatic urethra along a length of prostate
lobes, according to some embodiments of the invention, are analogous to that illustratively
described hereinabove regarding the exemplary prostatic implant 200 as shown in FIGs.
3A and 3B.
[0093] Accordingly, in a manner analogous to that shown in FIG. 3A, prostatic implant 300,
when in a stressed (e.g., compressed or folded) configuration, may be inserted into
the (BPH exhibiting) anatomical region portion 110 shown in FIG. 1C. For example,
with reference made to FIG. 3A, exemplary prostatic implant 200 can be substituted
with exemplary prostatic implant 300, for highlighting exemplary (insertion stage)
positioning and configuration of the stressed (compressed or folded) prostatic implant
300 relative to the (compressed) prostatic urethra 106 and the prostatic lobes (left
and right prostatic lateral lobes 114a and 114b, respectively, and prostatic medial
lobe 116).
[0094] Additionally, for example, with reference made to FIG. 3B, exemplary prostatic implant
200 can be substituted with exemplary prostatic implant 300, for schematically illustrating
the stressed (compressed or folded) configuration of exemplary prostatic implant 300
following release thereof inside the (BPH exhibiting) anatomical region portion 110.
According to such analogy, FIG. 3B, prostatic implant 200 being replaced by prostatic
implant 300, would then highlight exemplary (release or unfolding stage) positioning
and configuration of the 'less-stressed' (partially or entirely unfolded) prostatic
implant 300 relative to the 'more-stressed' prostatic urethra 106 and the prostatic
lobes. Structural change of the prostatic implant 300 (in changing from the stressed
(compressed or folded) configuration to the non-stressed (partially or entirely unfolded)
configuration is accompanied by radially directed forces outwardly originating from
the distal and proximal retractors 302 and 306, respectively, in a manner such that
the prostatic implant 300 laterally expands (i.e., unfolds) and changes from a stressed
(compressed or folded) configuration to a non-stressed (partially or entirely unfolded)
configuration. Moreover, such structural change of the prostatic implant 300, via
the radially directed forces outwardly originating from the distal and proximal retractors
302 and 306, respectively, translates into laterally directed pushing or pressure
forces exerted by the distal and proximal retractors 302 and 306, respectively, upon
those potions of the prostatic lobes (left and right prostatic lateral lobes 114a
and 114b, respectively, and prostatic medial lobe 116) in contact with the prostatic
implant, in general, and in contact with the distal and proximal retractors 302 and
306, respectively, in particular.
[0095] Reference is again made to FIG. 4A, schematically illustrating a perspective view
of exemplary prostatic implant 300, for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes, highlighting
some prostatic implant components. According to such an alternative exemplary embodiment,
exemplary prostatic implant 300, in a non-limiting manner, includes: an elongated
spine member 310 having a spinal longitudinal axis 312, and, a first elongated edge
member 314 and a second elongated edge member 316 symmetrically opposing each other
relative to the spinal longitudinal axis 312. Therein, each of the first and second
elongated edge members 314 and 316, respectively, is interconnected to the spine member
310 via at least one interconnecting member, for example, interconnecting member 320.
[0096] According to this exemplary embodiment, exemplary prostatic implant 300 additionally
includes at least one tissue support member, for example, first tissue support member
322, extending between the first elongated edge member 314 and the spinal longitudinal
axis 312, and at least one other tissue support member, for example, second tissue
support member 324, extending between the second elongated edge member 316 and the
spinal longitudinal axis 312. Therein, each of the tissue support members, for example,
each of the first and second tissue support members 322 and 324, respectively, is
sized and configured for supporting a portion of a prostatic lateral lobe (for example,
left or right prostatic lateral lobe 114a or 114b, respectively, shown in FIGs. 1C,
3A, 3B) when the spine member 310 engages an anterior interlobar groove (for example,
anterior interlobar groove 118 shown in FIGs. 1C, 3A, 3B) that extends between prostatic
lateral lobes, and when the first and second elongated edge members 314 and 316, respectively,
engage corresponding posterolateral interlobar grooves (for example, left and right
posterolateral interlobar grooves 120a and 120b, shown in FIGs. 1C, 3A, 3B).
[0097] Additional exemplary and optional technical features, characteristics, and properties
of an implant, for example, prostatic implant 300, for retracting or/and supporting
periurethral tissue enclosing a prostatic urethra along a length of prostate lobes,
according to some embodiments of the invention, are illustratively described as follows.
[0098] In exemplary embodiments, the spine member 310 has a length being equal to or less
than length of the anterior interlobar groove 118 or/and substantially less than the
length of each of the first and second elongated edge members 314 and 316, respectively.
In exemplary embodiments, the first elongated edge member 314 is sized for positioning
in the left posterolateral interlobar groove 120a that extends between the left prostatic
lateral lobe 114a and the prostatic medial lobe 116, and the second elongated edge
member 316 is sized for positioning in the right posterolateral interlobar groove
120b that extends between the right prostatic lateral lobe 114b and the prostatic
medial lobe 116.
[0099] In exemplary embodiments, the prostatic implant 300 is configured to anchor the anterior
interlobar groove 118, and, the left and right posterolateral interlobar grooves 120a
and 120b, respectively, by continuously exerting a radially directed pushing force
thereupon, within a range of between about 100 grams and about 1,000 grams, so as
to prevent or minimize axial or/and rotational movement of the anchored anterior interlobar
groove 118, and, the posterolateral interlobar grooves 120a and 120b. In exemplary
embodiments, the prostatic implant 300 is configured to anchor the anterior interlobar
groove 118, and, the left and right posterolateral interlobar grooves 120a and 120b,
respectively, by continuously exerting a radially directed pushing force thereupon,
so as to increase distance separating superior portions of the interlobar grooves
and increase distance separating left and right inferior portions of the interlobar
grooves, or/and to maintain a distance of at least 2 mm between the prostatic lateral
lobes, by exerting lateral forces thereupon within a range of between about 100 grams
and about 1,000 grams.
[0100] In exemplary embodiments, implant 300 is shown in FIG. 4A as fully unfolded and fully
unstressed, having its double wings-like structure fully opened and expanded laterally.
In exemplary embodiments, each of the interconnecting members, for example, interconnecting
member 320, includes at least one elastic portion, for example, elastic portion 328,
adjoining the spine member 310, such that the elastic portion 328 is non-stressed
when the first and second elongated edge members 314 and 316, respectively, are pivotally
positioned centrally away from each other about the spinal longitudinal axis 312,
so as to form a predetermined maximal spanning angle between opposing interconnecting
members. In exemplary embodiments, the predetermined maximal spanning angle is within
a range of between about 60° and about 140°. In exemplary embodiments, each elastic
portion, for example, elastic portion 328, adjoining the spine member 310 exhibits
an increase in stress (compression) when subjected to a moment of force that pivotally
shifts the first and second elongated edge members 314 and 316, respectively, towards
each other about the spinal longitudinal axis 312.
[0101] In exemplary embodiments, the first and second edge members 314 and 316, respectively,
are configured to approach each other so as to form an elongated edge member spanning
angle being equal to or greater than about 60° degrees. In such exemplary embodiments,
each of the first and second elongated edge members 314 and 316, respectively, or/and
each of the first and second tissue support members 322 and 324, respectively, exerts
a total lateral pressing force upon a corresponding prostatic lateral lobe. In exemplary
embodiments, the total lateral pressing force is in a range of between about 100 grams
and about 1,000 grams.
[0102] In exemplary embodiments, each of the first and second tissue support members 322
and 324, respectively, is configured as a curvilinear portion of the first elongated
edge member 314 or/and the second elongated edge member 316 protruding towards the
spinal longitudinal axis 312. In exemplary embodiments, each of the first and second
tissue support members 322 and 324, respectively, is configured as a curvilinear portion
of the first elongated edge member 314 or/and the second elongated edge member 316
that protrudes laterally outwardly from an area encompassed by the first elongated
edge member 314 or/and the second elongated edge member 316 and the spine member 310.
[0103] FIG. 4C schematically illustrates a top view of the exemplary prostatic implant 300
shown in FIG. 4A, in a fully non-stressed configuration, highlighting a cranial-nose
portion 340 thereof and a caudal-nose portion 342 thereof.
[0104] In exemplary embodiments, for example, as shown in FIG. 4C, at least one of the first
and second elongated edge members 314 and 316, respectively, has a cranial-nose portion,
for example, cranial-nose portion 340, shaped and configured for resting against a
ledge imposed by a urinary bladder neck segment adjacent the prostatic urethra (e.g.,
108 in FIG. 1A), so as to prevent cranial dislodgement of the prostatic implant 300
into the urinary bladder (e.g., 102 in FIG. 1A), when the spine member 310 engages
an anterior interlobar groove (e.g., 118 in FIG. 1C) that extends between the prostatic
lateral lobes (e.g., 114a and 114b in FIGs. 1C, 3A, 3B), and when the first and second
elongated edge members 314 and 316, respectively, engage corresponding posterolateral
interlobar grooves (e.g., 120a and 120b in FIGs. 1C, 3A, 3B). In such exemplary embodiments,
the cranial-nose portion 340 is "L" shaped.
[0105] In exemplary embodiments, for example, as also shown in FIG. 4C, at least one of
the first and second elongated edge members 314 and 316, respectively, has a caudal-nose
portion, for example, caudal-nose portion 342, shaped and configured for resting against
a narrowing imposed by the external urethral sphincter adjacent to the verumontanum
of the prostatic urethra, so as to prevent caudal migration of the prostatic implant
300 through the external sphincter and into the bulbar urethra, when the spine member
302 engages an anterior interlobar groove (e.g., 118 in FIG. 1C) that extends between
the prostatic lateral lobes (e.g., 114a and 114b in FIGs. 1C, 3A, 3B), and when the
first and second elongated edge members 314 and 316, respectively, engage corresponding
posterolateral interlobar grooves (e.g., 120a and 120b in FIGs. 1C, 3A, 3B). In such
exemplary embodiments, the caudal-nose portion 342 is "L" shaped.
[0106] FIG. 5 schematically illustrates the exemplary prostatic implant shown in FIG. 4C,
highlighting inclusion therein of a plurality of exemplary tissue support members
350, 352, 354, and 356, where each such tissue support member is configured as a rib
or rib-type member.
[0107] FIG. 6 schematically illustrates the exemplary prostatic implant shown in FIG. 4C,
highlighting inclusion therein of a pair of exemplary first and second tissue support
members 360 and 362, with each such tissue support member including a tissue contacting
surface, for example, first and second tissue contacting surfaces 364 and 366, respectively.
[0108] In exemplary embodiments, at least one of the tissue support members, for example,
at least one of the first and second tissue support members 322 and 324, respectively,
or/and rib or rib-type tissue support member 318, includes a tissue contacting surface,
such as tissue contacting surface 364 or 366, sized or/and shaped according to dimensions
of a portion of a prostatic lateral lobe (for example, left or right prostatic lateral
lobe 114a or 114b, respectively, shown in FIGs. 1C, 3A, 3B).
[0109] An aspect of some embodiments of the present invention is a system (herein, also
referred to as a prostatic implant system) for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes. In exemplary
embodiments, the prostatic implant system, in a non-limiting manner, includes: an
implant (prostatic implant), and an implant (prostatic implant) manipulator detachably
connected to the implant (prostatic implant). Therein, the prostatic implant includes
a plurality of elongated edge members interconnected in a form of a collapsible-expandable
frame expandable to retract or/and support periurethral tissue by exerting pushing
forces upon interlobar grooves located along the prostatic urethra. Additionally,
therein, a first one of the elongated edge members includes a first craniolateral
corner and a first caudolateral corner, and a second one of the elongated edge members
includes a second craniolateral corner opposing the first craniolateral corner and
a second caudolateral corner opposing the first caudolateral corner. In such exemplary
embodiments, the implant manipulator is configured to manipulate and force the implant
first and second caudolateral corners into close proximity with each other.
[0110] Any of the hereinabove illustratively described exemplary embodiments of an implant
(prostatic implant), such as exemplary prostatic implant 200 or exemplary prostatic
implant 300, for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes may be included as part of, and used for
implementing, the herein disclosed exemplary embodiments of a system (prostatic implant
system) for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes.
[0111] For example, reference is made to FIG. 7A which schematically illustrates an exemplary
embodiment of a system (prostatic implant system), indicated as, and referred to by,
reference number 400, for retracting or/and supporting periurethral tissue enclosing
a prostatic urethra along a length of prostate lobes, highlighting some system components.
Therein, an exemplary prostatic implant (such as prostatic implant 300 shown in FIGs.
4A and 4C), in a stressed (e.g., bent, contracted or/and compressed, folded type)
configuration and operatively connected to the distal end of an exemplary cystoscope
402, is entirely held within an exemplary compression sleeve 404 by an implant manipulator
410 (also described below and shown in more details in FIGs. 8E - 8G, and 8M).
[0112] With reference to FIG. 7A, and FIGs. 4A - 4C, exemplary prostatic implant system
400, in a non-limiting manner, includes: an implant (prostatic implant) 300, and an
implant (prostatic implant) manipulator 410 detachably connected to the prostatic
implant 300. Therein, the prostatic implant 300 includes a plurality of elongated
edge members, for example, first and second elongated edge members 314 and 316, respectively,
interconnected in a form of a collapsible-expandable frame expandable to retract or/and
support periurethral tissue by exerting pushing forces upon interlobar grooves located
along the prostatic urethra (e.g., as illustratively described hereinabove with reference
to FIGs. 1A - 1C, and 3A - 3B). Additionally, therein, the first elongated edge member
314 includes a first craniolateral corner 304a and a first caudolateral corner 308a,
and the second elongated edge member 316 includes a second craniolateral corner 304b
opposing the first craniolateral corner 304a and a second caudolateral corner 308b
opposing the first caudolateral corner 308a. In such exemplary embodiments, the implant
manipulator 410 (e.g., FIGs. 8E - 8G) is configured to manipulate and force the prostatic
implant first and second caudolateral corners 308a and 308b, respectively, into close
proximity with each other.
[0113] Additional exemplary and optional technical features, characteristics, and properties,
as well as exemplary implementation and use, of a system, for example, prostatic implant
system 400, for retracting or/and supporting periurethral tissue enclosing a prostatic
urethra along a length of prostate lobes, according to some embodiments of the invention,
are illustratively described as follows.
[0114] FIGs. 7B - 7C schematically illustrate exemplary embodiments of the prostatic implant
system 400, highlighting progressive (sequential) stages of operation thereof, wherein
the exemplary prostatic implant 300 is deployed via progressively (sequentially) being
pushed out of the compression sleeve 404 by the implant manipulator 410, along with
undergoing a type of unfolding of at least some of its structural members. At first
(FIG. 7B), distal retractor 302 emerges and then immediately unfolds, at least partly,
while the other part of implant 300 is held folded and compressed in compression sleeve
404; followed by (FIG. 7C) complete extraction of implant 300 from within compression
sleeve 404, where implant 300 is unfolded at least partly along most or all its entire
length. FIG. 7D schematically illustrates the exemplary prostatic implant 300, following
deployment by the prostatic implant system 400, in a 'stand-alone' non-stressed, unfolded
and expanded configuration after exiting the compression sleeve 404 and detachment
from the implant manipulator 410.
[0115] In exemplary embodiments of prostatic implant system 400, the implant manipulator
410 (e.g., FIGs. 8E - 8G) is configured for progressively (sequentially) changing
the shape or form of the prostatic implant 300 according to different progressive
or sequential implant deployment configurations, including at least one of the following.
> A fully collapsed delivery configuration, whereby the implant first and second craniolateral
corners 304a and 304b, respectively, are in close proximity with each other, and,
the implant first and second caudolateral corners 308a and 308b, respectively, are
in close proximity with each other, for example, as shown in FIG. 7A. In exemplary
embodiments, such a fully collapsed delivery configuration of the prostatic implant
300 corresponds to a fully folded configuration, whereby at least some of the prostatic
implant structural members are in a type of a fully folded form.
> A partially collapsed positioning configuration, whereby the implant first and second
craniolateral corners 304a and 304b, respectively, are distanced apart from each other,
and, the implant first and second caudolateral corners 308a and 308b, respectively,
are in close proximity with each other, for example, as shown in FIG. 7B. In exemplary
embodiments, such a partially collapsed positioning configuration of the prostatic
implant 300 corresponds to a partially folded / partially unfolded configuration,
whereby at least some of the prostatic implant structural members are in a type of
a partially folded form while at least some others of the prostatic implant structural
members are in a type of a partially unfolded form. In exemplary embodiments, the
partially collapsed positioning configuration includes the prostatic implant 300 having
a frustum or cone-like shape whose distal-most diameter thereof is greater than the
smallest cross-sectional dimension in a urinary bladder neck joining the prostatic
urethra (e.g., 108 and 106, respectively, in FIG. 1A), and whose proximal-most diameter
thereof is smaller than the smallest cross-sectional dimension in the urinary bladder
neck.
> An expanded deployed configuration, whereby the implant first and second craniolateral
corners 304a and 304b, respectively, are distanced apart from each other, and, the
implant first and second caudolateral corners 308a and 308b, respectively, are distanced
apart from each other, for example, as shown in FIG. 7C and 7D. In exemplary embodiments,
such an expanded deployed configuration of the prostatic implant 300 corresponds to
a fully unfolded configuration, whereby at least most, or all, of the prostatic implant
structural members are in a type of a fully unfolded form.
[0116] In exemplary embodiments, the implant manipulator 410 (e.g., FIGs. 8E - 8G), when
connected to the prostatic implant 300, is configured for applying thereto at least
one of rotational forces, pulling forces, and pushing forces. The implant manipulator
410 applies such forces to the prostatic implant 300 so as to facilitate and effect
preceding illustratively described progressive (sequential) changing of the shape
or form of the prostatic implant 300, according to the different progressive or sequential
prostatic implant deployment configurations.
[0117] In exemplary embodiments, the implant manipulator 410 includes a tubular member,
for example, tubular member 412, and a tether, for example, tether 414, releasably
intertwined through both of the implant first and second caudolateral corners. In
such exemplary embodiments, the implant manipulator 410 is configured for continuously
or/and selectively pulling the prostatic implant 300 via an operator using the tether
414 against a distal end 416 of the tubular member 412.
[0118] In exemplary embodiments, the prostatic implant system 400 additionally includes
an over-sheath, for example, over-sheath 418 shown in FIGs. 8A - 8C, sized for covering
a length of the cystoscope 402 having a cystoscope lumen (e.g., as a type of 'working
channel') dimensioned to restrain the prostatic implant 300 in the fully collapsed
delivery configuration (e.g., FIG. 7A) via at least encircling the implant first and
second craniolateral corners.
[0119] In such exemplary embodiments, the implant manipulator 410 is configured for manipulating
and shifting the prostatic implant 300 within the over-sheath lumen between the fully
collapsed (fully folded) delivery configuration (FIG. 7A) and the partially collapsed
(and partially unfolded) positioning configuration (FIG. 7B). Such manipulating and
shifting is effected by the implant manipulator 410 pushing or pulling the prostatic
implant 300 relative to the over-sheath lumen until the implant first and second craniolateral
corners 304a and 304b, respectively, are released from the implant manipulator over-sheath
418. Additionally, in such exemplary embodiments, the implant manipulator 410 is configured
for manipulating and shifting the prostatic implant 300 between the partially collapsed
(and partially unfolded) delivery configuration (FIG. 7B) and the expanded (and partially
or fully unfolded along most/all implant 300 length) deployed configuration (FIGs.
7C, 7D). Such manipulating and shifting is effected by the implant manipulator 410
detaching from the prostatic implant 300 after release of the tether 414 from the
implant first and second caudolateral corners 308a and 308b, respectively.
[0120] As stated above, any of the hereinabove illustratively described exemplary embodiments
of an implant (prostatic implant) for retracting or/and supporting periurethral tissue
enclosing a prostatic urethra along a length of prostate lobes may be included as
part of, and used for implementing, the herein disclosed exemplary embodiments of
a system (prostatic implant system) for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes.
[0121] Thus, with reference again made to FIG. 7A, and FIGs. 4A - 4C, in exemplary embodiments
of prostatic implant system 400, the prostatic implant 300 includes: an elongated
spine member 310 having a spinal longitudinal axis 312, and, first and second elongated
edge members 314 and 316, respectively, symmetrically opposing each other relative
to the spinal longitudinal axis 312, and interconnected to the spine member 310 via
at least one interconnecting member 320. In such exemplary embodiments, the spine
member 310 has a length being equal to or less than length of an anterior interlobar
groove (e.g., 118 in FIGs. 1C, 3A, 3B) that extends between prostatic lateral lobes
(e.g., left and right prostatic lateral lobes 114a and 114b, respectively, in FIGs.
1C, 3A, 3B), or/and substantially less than length of each of the first and second
elongated edge members 314 and 316, respectively.
[0122] Further, in such exemplary embodiments of prostatic implant system 400 including
prostatic implant 300, with additional reference made to FIGs. 1C, 3A, and 3B, the
first elongated edge member 314 is sized for positioning in a left posterolateral
interlobar groove 120a that extends between a left prostatic lateral lobe 114a and
a prostatic medial lobe 116, and the second elongated edge member 316 is sized for
positioning in a right posterolateral interlobar groove 120b that extends between
a right prostatic lateral lobe 114b and the prostatic medial lobe 116.
[0123] Further, in such exemplary embodiments of prostatic implant system 400 including
prostatic implant 300, at least one of the implant first and second craniolateral
corners 304a and 304b, respectively, are shaped and configured for resting against
a ledge imposed by the urinary bladder neck (e.g., 108) so as to prevent cranial dislodgement
of the prostatic implant 300 into the urinary bladder (e.g., 102), when the spine
member 310 engages an anterior interlobar groove (e.g., 118) that extends between
prostatic lateral lobes (e.g., 114a and 114b), and when the first and second elongated
edge members 314 and 316, respectively, engage corresponding posterolateral interlobar
grooves (e.g., 120a and 120b).
[0124] Further, in such exemplary embodiments of prostatic implant system 400 including
prostatic implant 300, at least one of the implant first and second caudolateral corners
308a and 308b, respectively, are shaped and configured for resting against a narrowing
imposed by the external urethral sphincter adjacent the verumontanum of the prostatic
urethra, so as to prevent caudal shift of the prostatic implant 300, when the spine
member 310 engages an anterior interlobar groove (e.g., 118) that extends between
prostatic lateral lobes (e.g., 114a and 114b), and when the first and second elongated
edge members 314 and 316, respectively, engage corresponding posterolateral interlobar
grooves (e.g., 120a and 120b). In such exemplary embodiments, each of the implant
first and second caudolateral corners 308a and 308b, respectively, has a shape or
form of a proximally directed apex, wherein the apex is formed by intersection of
converging curved slopes of respective ones of the implant first and second caudolateral
corners 308a and 308b, respectively.
[0125] An aspect of some embodiments of the present invention is a method (herein, also
referred to as a prostatic implant method) for retracting or/and supporting periurethral
tissue enclosing a prostatic urethra along a length of prostate lobes.
[0126] In exemplary embodiments, the prostatic implant method, in a non-limiting manner,
includes:
> Providing an implant along a chosen length of the prostate lobes.
> Exerting continuous radially directed pushing forces upon the anterior interlobar
groove between the prostate lobes, and upon at least one of the left and right posterolateral
interlobar grooves between the prostate lobes, thereby anchoring the implant in-place.
> Exerting lateral pressing forces upon one or more of prostatic lateral lobes, thereby
retracting or/and supporting the periurethral tissue.
[0127] In alternative exemplary embodiments, the prostatic implant method, in a non-limiting
manner, includes:
> Providing an implant in a fully collapsed delivery configuration, the implant includes
an independently actuatable distal retractor incorporating first and second craniolateral
corners, and an independently actuatable proximal retractor incorporating first and
second caudolateral corners, wherein the first and second craniolateral corners are
in close proximity to each other, and, the first and second caudolateral corners are
in close proximity to each other.
> Passing the implant in the fully collapsed delivery configuration, in a cranial
direction in a subject's urethra, into the subject's urinary bladder.
> Expanding, optionally by unfolding, the distal retractor within inner boundaries
of the urinary bladder.
> Positioning under vision the implant in the prostatic urethra along the length of
the prostate lobes.
> Expanding, optionally by unfolding, the proximal retractor so as to effect changing
the configuration of the implant from the fully collapsed (fully folded) delivery
configuration, into an expanded (fully unfolded) deployed configuration wherein the
first and second craniolateral corners are distanced apart from each other, and, the
first and second caudolateral corners are distanced apart from each other. In some
embodiments, unfolding or/and expanding of the implant is two-fold or/and multi-dimensional,
for example by unfolding from a collapsed-thin form to larger, radially-expanded,
size, in parallel to or followed by lateral expansion thereof.
[0128] Any of the hereinabove illustratively described exemplary embodiments of an implant
(prostatic implant), such as exemplary prostatic implant 200 or exemplary prostatic
implant 300, and any of the hereinabove illustratively described exemplary embodiments
of a system (prostatic implant system), such as exemplary prostatic implant system
400, for retracting or/and supporting periurethral tissue enclosing a prostatic urethra
along a length of prostate lobes, may be included as part of, and used for implementing,
the herein disclosed exemplary embodiments of a method (prostatic implant method)
for retracting or/and supporting periurethral tissue enclosing a prostatic urethra
along a length of prostate lobes.
[0129] For example, reference is made to FIGs. 8A - 8N which schematically illustrate various
stages of delivering and deploying an exemplary prostatic implant, such as prostatic
implant 300 illustratively described hereinabove and shown in FIGs. 4A, 4C, and 7D,
for retracting or/and supporting periurethral tissue enclosing a prostatic urethra
along a length of prostate lobes, using an exemplary system, such as prostatic implant
system, such as prostatic implant system 400 illustratively described hereinabove
and shown in FIGs. 7A - 7C).
[0130] As shown in FIG. 8A, over-sheath 418 is sleeved over the longitudinal body 419 of
a urological endoscope, particularly, a cystoscope (also known as a lithoscope), for
example, cystoscope 402. Then some preliminary steps may be taken by an operator,
such as a medical practitioner, in order to scan the treatment area or/and to measure
patient-specific anatomical dimensions, optionally, in order to select an implant
of proper size for a chosen result.
[0131] With reference to FIG. 8B, over-sheath 418, together with cystoscope 402, is then
extended throughout the length of the prostatic urethra 106sa, where the cystoscope
distal end 420 is provided adjacent to or inside of the urinary bladder 102sa. In
FIG. 8B, the prostatic urethra 106sa, the urinary bladder 102sa, and the bladder neck
108sa, are drawn for illustrative purposes only, and, in a non-limiting manner, may
be considered 'simulated analogs' of the corresponding bodily organs or parts, namely,
prostatic urethra 106, urinary bladder 102, and bladder neck 108, schematically shown
in FIGs. 1A - 1C.
[0132] Cystoscope 402 is removed from the prostatic urethra 106sa while, optionally, keeping
over-sheath 418 in place (as shown in FIG. 8C). Optionally, compression sleeve 404
is then loaded over cystoscope outer periphery 420 (as shown in FIG. 8D), in preparation
of loading prostatic implant 300 into the cystocope 402 and collapsing of the prostatic
implant 300 using the compression sleeve 404.
[0133] In order to collapse (e.g., via folding) the prostatic implant 300 from being in
a non-stressed fully opened configuration to being in a fully collapsed (fully folded)
delivery configuration, and insert prostatic implant 300 into the working channel
422 of the cystoscope 402, a tether 414, is first intertwined (unless it is readily
provided as such), optionally, releasably, through both the first and second craniolateral
corners 304a and 304b, respectively, of distal retractor 302 of implant 300. First
and second craniolateral corners are then urged the into close proximity to each other,
so as to effect changing of the prostatic implant 300 into the partially collapsed
(partially folded / partially unfolded) positioning configuration, by pulling tether
414 against the distal end 416 of the tubular member 412.
[0134] The implant manipulator 410, which can assist in exemplary subsequent steps, such
as of implant delivery, positioning or/and activating, can be formed by threading
tether 414 through the lumen of the tubular member 412, and optionally fixating proximal
end (e.g., proximal both free ends 414a and 414b) of tether 414 relative to the proximal
end 424 of tubular member 412. FIG. 8E demonstrates an exemplary formation of the
implant manipulator 410 connected with the prostatic implant 300, also forcing it
into the partially collapsed (partially folded / partially unfolded) positioning configuration.
[0135] As shown in FIG. 8F, the implant manipulator 410, with the prostatic implant 300
connected thereto, are then loaded into a lumen (e.g., working channel 422) of the
cystoscope 402. Optionally, the proximal end of the implant manipulator 410 is passed
into the distal opening of the working channel 422 (FIG. 8F(i)), while the proximal
end of the implant manipulator 410 is drawn from a proximal opening 430 of the working
channel 422 (FIG. 8F(ii)). FIG. 8G shows the prostatic implant 300 in its partially
collapsed (partially folded / partially unfolded) positioning configuration coupled
to the cystoscope 402 using the implant manipulator 410 (not shown, fully inserted
within working channel 422).
[0136] As shown in FIG. 8H, the prostatic implant 300 is then forced into a fully collapsed
(fully folded) delivery configuration using the compression sleeve 402, by drawing
the compression sleeve 404 over entire length of the prostatic implant 300. The compression
sleeve 404 incorporates a lumen 432 sized for effecting changing of the configuration
of the prostatic implant 300 from the partially collapsed (partially folded / partially
unfolded) positioning configuration to the fully collapsed (fully folded) delivery
configuration.
[0137] The prostatic implant 300 is then pushed distally through over-sheath 418 with the
cystoscope 402 (FIG. 8I) and passed, still in its fully collapsed (fully folded) delivery
configuration, in a cranial direction in the prostatic urethra 106sa, into the urinary
bladder 102sa of the subject. Then, the prostatic implant distal retractor 302 is
released from its restricting boundary, namely, the working channel 422 and the over-sheath
418, until at least the distal retractor 302, and, optionally, also the proximal retractor
306, protrudes in a cranial direction from the prostatic urethra 106sa (as shown,
for example, in FIG. 8J). This may be effected by either pushing the prostatic implant
300, optionally relative to the over-sheath 418, or/and the cystoscope 402 further
into the urinary bladder 102sa, or by holding the prostatic implant 300 in the urinary
bladder 102sa, using the implant manipulator 410, while proximally pulling over-sheath
418 or/and the cystoscope 402.
[0138] Releasing the prostatic implant 300 should effect expansion of the distal retractor
302 within inner boundaries of the urinary bladder 102sa into the partially collapsed
(partially folded / partially unfolded) positioning configuration, resulting in the
first and second craniolateral corners 304a and 304b, respectively, being distanced
apart from each other, and, the first and second caudolateral corners 308a and 308b,
respectively, being kept in close proximity to each other.
[0139] Then, under vision, using the cystoscope 402, the prostatic implant 300 is positioned
in the prostatic urethra 106sa along the length of the prostate lobes, as shown in
part, in FIG. 8K. The prostatic implant 300 positioning in the prostatic urethra 106sa
may include at least one of the following steps, not necessarily in same order:
> Rotating the prostatic implant 300, by applying torque forces, relative to the spinal
longitudinal axis 312 so as to align the spine member 310 with the anterior interlobar
groove of the prostatic urethra 106sa, or/and to align the first elongated edge member
314 with the left posterolateral interlobar groove of the prostatic urethra 106sa,
or/and to align the second elongated edge member 316 with the right posterolateral
interlobar groove of the prostatic urethra 106sa.
> Pulling the prostatic implant 300 in a caudal direction to a position within the
prostatic urethra 106sa or/and placing the first and second craniolateral corners
304a and 304b, respectively, against a narrowing imposed by the internal urethral
sphincter adjacent to the urinary bladder neck 108sa.
> Inserting the spine member 310 in the anterior interlobar groove of the prostatic
urethra 106sa, or/and inserting the first elongated edge member 314 in the left posterolateral
interlobar groove of the prostatic urethra 106sa, or/and inserting the second elongated
edge member 316 in the right posterolateral interlobar groove of the prostatic urethra
106sa.
> Visually verifying the alignment using cystoscopy (with the cystoscope 402).
[0140] The prostatic implant 300 positioning should result, if the prostatic implant 300
is in its partially collapsed (partially folded / partially unfolded) positioning
configuration, in effecting expansion of a distal region of the prostatic urethra
106sa, using the distal retractor 302, into a greater lumen size than an adjacent
proximal region of the prosthetic urethra 106sa. The distal retractor 302 may also
be partially collapsed into conformity with anatomy of the distal region of the prostatic
urethra 106sa. FIG. 8L provides a frontal (caudally directed) view for an exemplary
representation of proper positioning of the prostatic implant 300 within the prostatic
urethra 106sa. By also expanding (unfolding) the proximal retractor 306, the configuration
of the prostatic implant 300 can be changed from the fully collapsed (fully folded)
delivery configuration into an expanded (fully unfolded) deployed configuration. Optionally,
in exemplary embodiments, such expansion (unfolding) of the prostatic implant 300
is effected in a partial manner, whereby at least most, but not necessarily all, of
the prostatic implant 300 structural members change into a fully expanded (unfolded)
configuration, for example, possibly due to physical size and dimensional restrictions
imposed by the in-vivo environment of the periurethral tissue and the surrounding
prostatic lobes. The expansion (unfolding) procedure results in the first and second
craniolateral corners 304a and 304b, respectively, to become distanced apart from
each other, and, the first and second caudolateral corners 308a and 308b, respectively,
to become distanced apart from each other as well. The first and second tissue support
members 322 and 324, respectively, of the prostatic implant 300 are also released
for supporting respective portions of the lateral prostatic lobes following implant
positioning.
[0141] The cystoscope 402 is then removed from the prostatic urethra 106sa, and from the
entire urethra of the subject, while keeping the over-sheath 418 in place.
[0142] Any of the hereinabove illustratively described steps or procedures of the herein
disclosed exemplary embodiments of a method (prostatic implant method) for retracting
or/and supporting periurethral tissue enclosing a prostatic urethra along a length
of prostate lobes, may be repeated in case there is a need to change (e.g., correct)
positioning of the prostatic implant 300, or of any portion or member thereof, in
relation to chosen anatomical or/and physiological considerations. Repeating any of
the previous steps may include, be preceded by, or be followed by, re-collapsing the
prostatic implant 300 back into the fully collapsed delivery configuration or/and
passing the prostatic implant 300 back into the urinary bladder 102sa. Repeating may
be persistent until reaching a chosen result. The chosen result can be verified under
vision, for example, using the cystoscope 402. The chosen result may include anchoring
different portions of the prostatic implant 300 in at least two of the anterior interlobar
grooves, the left posterolateral interlobar groove, and the right posterolateral interlobar
groove, of the prostatic urethra 106sa, within the boundaries of the prostate lobes.
The chosen result may also include lifting both prostatic lateral lobes so as to enlarge
minimal lumen size of the prostatic urethra 106sa, optionally, to at least 1 mm, or
at least 2 mm, along a continuous length of the prostatic urethra, optionally along
its entire length, optionally, by shifting each of the prostatic lateral lobes, pivotally,
relative to the anterior interlobar groove.
[0143] Once it is verified that the prostatic implant 300 is in appropriate positioning
within the prostatic urethra 106sa, final deployment and implantation stages can take
place, and the prostatic implant 300 should be left therein, with no further interaction
with the implant manipulator 410. Accordingly, the fully deployed and implanted prostatic
implant 300 is thereby configured and positioned to continuously exert radially directed
pushing forces upon the anterior interlobar groove and at least one of the left and
right posterolateral interlobar grooves. This may facilitate preventing or minimizing
possible axial or/and rotational movement of the prostatic implant 300, or/and to
increase distance separating the superior interlobar grooves and to increase distance
separating the left and right inferior-lateral interlobar grooves. Such may also facilitate
the prostatic implant 300 to exert lateral pressing forces upon each prostatic lateral
lobe, thereby, retracting or/and supporting the periurethral tissue.
[0144] As shown in FIGs. 8M and 8N, the implant manipulator 410 is taken apart into its
main parts, namely, the tubular member 412 and the tether 414 (partly shown in FIG.
8M, illustrating scissoring of the implant manipulator 410), and the tether 414 is
pulled and withdrawn from holding the prostatic implant 300 and subsequently, from
the subject's body (FIG. 8N).
[0145] Each of the following terms written in singular grammatical form: 'a', 'an', and
'the', as used herein, means 'at least one', or 'one or more'. Use of the phrase 'one
or more' herein does not alter this intended meaning of 'a', 'an', or 'the'. Accordingly,
the terms 'a', 'an', and 'the', as used herein, may also refer to, and encompass,
a plurality of the stated entity or object,
unless otherwise specifically defined or stated herein, or,
unless the context clearly dictates otherwise. For example, the phrases: 'a unit', 'a device', 'an assembly', 'a mechanism', 'a
component', 'an element', and 'a step or procedure', as used herein, may also refer
to, and encompass, a plurality of units, a plurality of devices, a plurality of assemblies,
a plurality of mechanisms, a plurality of components, a plurality of elements, and,
a plurality of steps or procedures, respectively.
[0146] Each of the following terms: 'includes', 'including', 'has', 'having', 'comprises',
and 'comprising', and, their linguistic / grammatical variants, derivatives, or/and
conjugates, as used herein, means 'including, but not limited to', and is to be taken
as specifying the stated component(s), feature(s), characteristic(s), parameter(s),
integer(s), or step(s), and does not preclude addition of one or more additional component(s),
feature(s), characteristic(s), parameter(s), integer(s), step(s), or groups thereof.
Each of these terms is considered equivalent in meaning to the phrase 'consisting
essentially of.
[0147] Each of the phrases 'consisting of and 'consists of', as used herein, means 'including
and limited to'.
[0148] The phrase 'consisting essentially of', as used herein, means that the stated entity
or item (system, system unit, system sub-unit, device, assembly, sub-assembly, mechanism,
structure, component, element, or, peripheral equipment, utility, accessory, or material,
method or process, step or procedure, sub-step or sub-procedure), which is an entirety
or part of an exemplary embodiment of the disclosed invention, or/and which is used
for implementing an exemplary embodiment of the disclosed invention, may include at
least one additional 'feature or characteristic' being a system unit, system sub-unit,
device, assembly, sub-assembly, mechanism, structure, component, or element, or, peripheral
equipment, utility, accessory, or material, step or procedure, sub-step or sub-procedure),
but only if each such additional 'feature or characteristic' does not materially alter
the basic novel and inventive characteristics or special technical features, of the
claimed entity or item.
[0149] The term 'method', as used herein, refers to steps, procedures, manners, means, or/and
techniques, for accomplishing a given task including, but not limited to, those steps,
procedures, manners, means, or/and techniques, either known to, or readily developed
from known steps, procedures, manners, means, or/and techniques, by practitioners
in the relevant field(s) of the disclosed invention.
[0150] Throughout this disclosure, a numerical value of a parameter, feature, characteristic,
object, or dimension, may be stated or described in terms of a numerical range format.
Such a numerical range format, as used herein, illustrates implementation of some
exemplary embodiments of the invention, and does not inflexibly limit the scope of
the exemplary embodiments of the invention. Accordingly, a stated or described numerical
range also refers to, and encompasses, all possible sub-ranges and individual numerical
values (where a numerical value may be expressed as a whole, integral, or fractional
number) within that stated or described numerical range. For example, a stated or
described numerical range 'from 1 to 6' also refers to, and encompasses, all possible
sub-ranges, such as 'from 1 to 3', 'from 1 to 4', 'from 1 to 5', 'from 2 to 4', 'from
2 to 6', 'from 3 to 6', etc., and individual numerical values, such as '1', '1.3',
'2', '2.8', '3', '3.5', '4', '4.6', '5', '5.2', and '6', within the stated or described
numerical range of 'from 1 to 6'. This applies regardless of the numerical breadth,
extent, or size, of the stated or described numerical range.
[0151] Moreover, for stating or describing a numerical range, the phrase 'in a range of
between about a first numerical value
and about a second numerical value', is considered equivalent to, and meaning the same
as, the phrase 'in a range of
from about a first numerical value to about a second numerical value', and, thus, the
two equivalently meaning phrases may be used interchangeably. For example, for stating
or describing the numerical range of room temperature, the phrase 'room temperature
refers to a temperature in a range of between about 20 °C and about 25 °C', and is
considered equivalent to, and meaning the same as, the phrase 'room temperature refers
to a temperature in a range of from about 20 °C to about 25 °C'.
[0152] The term 'about', as used herein, refers to ± 10 % of the stated numerical value.
[0153] The phrase 'operatively connected', as used herein, equivalently refers to the corresponding
synonymous phrases 'operatively joined', and 'operatively attached', where the operative
connection, operative joint, or operative attachment, is according to a physical,
or/and electrical, or/and electronic, or/and mechanical, or/and electro-mechanical,
manner or nature, involving various types and kinds of hardware or/and software equipment
and components.
[0154] It is to be fully understood that certain aspects, characteristics, and features,
of the invention, which are, for clarity, illustratively described and presented in
the context or format of a plurality of separate embodiments, may also be illustratively
described and presented in any suitable combination or sub-combination in the context
or format of a single embodiment. Conversely, various aspects, characteristics, and
features, of the invention which are illustratively described and presented in combination
or sub-combination in the context or format of a single embodiment, may also be illustratively
described and presented in the context or format of a plurality of separate embodiments.
[0155] Although the invention has been illustratively described and presented by way of
specific exemplary embodiments, and examples thereof, it is evident that many alternatives,
modifications, or/and variations, thereof, will be apparent to those skilled in the
art. Accordingly, it is intended that all such alternatives, modifications, or/and
variations, fall within the spirit of, and are encompassed by, the broad scope of
the appended claims.
[0156] All publications, patents, and or/and patent applications, cited or referred to in
this disclosure are herein incorporated in their entirety by reference into the specification,
to the same extent as if each individual publication, patent, or/and patent application,
was specifically and individually indicated to be incorporated herein by reference.
In addition, citation or identification of any reference in this specification shall
not be construed or understood as an admission that such reference represents or corresponds
to prior art of the present invention. To the extent that section headings are used,
they should not be construed as necessarily limiting.